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Data-driven performance improvement in health care: the Joint Commission's Indicator Measurement System (IMSystem).

BACKGROUND: Since 1986, the Joint Commission has worked to create an evaluation system that would remain standards based but would accent an organization's performance as well as its capability to provide care. One component is the Indicator Measurement System (IMSystem), which involves continuous data collection and periodic feedback about specific performance measures, or indicators. An indicator is a quantitative measure of an aspect of patient care. It is not a direct measure of quality; rather it is a screen or flag which indicates areas for more detailed analysis. METHODOLOGY: Sets of indicators, each set related to specific important health care functions such as perioperative care, are established by expert task forces and are then subject to two phases of testing. Alpha testing addresses face validity and feasibility of data collection and may result in indicator revision. In the beta phase, a large group of organizations test the indicators for validity, reliability, and usefulness in improving performance. OPERATIONAL ISSUES: In 1994, the IMSystem will contain ten indicators and participation by hospitals will be voluntary. Once the value of these data in the accreditation process has been demonstrated--possibly as early as 1996--participation will become an integral component of accreditation. Hospitals will transmit indicator data to the Joint Commission but no patient or physician identifiers will leave the hospital. The system will provide organizations with information they can use to monitor and improve their performance, while helping meet external needs for performance measurement.

Data Collection↗

The ability of three-dimensional structural indices to reflect mechanical aspects of trabecular bone.

Bone mineral density (BMD) and bone microarchitecture are important determinants for the mechanical properties of cancellous bone. Although BMD alone is a good predictor of average mechanical properties of cancellous bone, there remains unexplained variation in mechanical properties that might be due to missing information regarding bone microarchitecture. Recent developments in three-dimensional (3D) structural analysis have provided possibilities for measuring a variety of structural indices to characterize bone microarchitecture. The objectives of this study were to calculate structural indices and elastic constants of human cancellous bone from different skeletal sites and to investigate the predictive value of different 3D structural indices for the elastic properties of bone. A total of 237 cancellous bone samples taken from the iliac crest, lumbar spine, femoral head, and calcaneus were imaged with a 3D microcomputed tomography (microCT) system. The segmented 3D images were used to calculate BV/TV, BS/TV, Tb.Th, Tb.Sp, Tb.N, and MII ratio and for microstructural finite-element (microFE) analysis to calculate Young's moduli, shear moduli, and Poisson's ratios. A subgroup of "critical" specimens within each site was selected to represent specimens that could not be identified as osteoporotic or normal on the basis of BMD measurement alone. For these "critical" specimens, structural indices and elastic constants were correlated by means of linear multivariate regression analysis. It was found that the elastic constants clearly correlated better when one of the 3D structural indices was included as independent variable than when BV/TV was the only independent variable. Each of the examined structural indices could improve the correlation: the R2 values were maximally increased from 53% (BV/TV alone) to 82% (BV/TV and MIL ratio). The most effective indices, however, were not the same for the different skeletal sites. Even better correlations were found when more than one of the 3D structural indices were included as independent variables: the R2 values were maximally increased from 53% (BV/TV alone) to 92% (BV/TV, Tb.Sp, and MIL ratio). The prediction of elastic constants for cancellous bone samples is clearly improved when BV/TV is supplemented with 3D structural indices. These results suggest that the determination of mechanical properties of bone and the diagnosis of osteoporosis can be improved if, in addition to BMD, the 3D bone microarchitecture is assessed in vivo.

Adult↗

Indicators of wetland condition for the prairie pothole region of the United States.

We describe a study designed to evaluate the performance of wetland condition indicators of the Prairie Pothole Region (PPR) of the north central United States. Basin and landscape scale indicators were tested in 1992 and 1993 to determine their ability to discriminate between the influences of grassland dominated and cropland dominated landscapes in the PPR. Paired plots were selected from each of the major regions of the PPR. Among the landscape scale indicators tested, those most capable of distinguishing between the two landscapes were: 1) frequency of drained wetland basins. 2) total length of drainage ditch per plot, 3) amount of exposed soil in the upland subject to erosion, 4) indices of change in area of wetland covered by water, and 5) number of breeding duck pairs. Basin scale indicators including soil phosphorus concentrations and invertebrate taxa richness showed some promise: however, plant species richness was the only statistically significant basin scale indicator distinguishing grassland dominated from cropland dominated landscapes. Although our study found a number of promising candidate indicators, one of our conclusions is that basin scale indicators present a number of implementation problems. including: skill level requirements, site access denials, and recession of site access by landowners. Alternatively, we suggest that the use of landscape indicators based on remote sensing can be an effective means of assessing wetland integrity.

Biomarkers↗

Relationship of total body fatness and five anthropometric indices in Chinese aged 20-40 years: different effects of age and gender.

OBJECTIVES: We aim to evaluate the ethnic-specific relationship of total fat mass and anthropometric indices in Chinese. DESIGN: Cross-section study. SETTING: This study was performed at the College of Life Sciences, Hunan Normal University, P.R. China. SUBJECTS AND METHOD: To increase our understanding of the relationship of total fat mass and anthropometric indices in Chinese, 793 females and 1091 males aged 20-40 years were randomly recruited from Changsha city of P. R. China. Hip circumference (HC) and waist circumference (WC) were measured using standardized equipments, and other three anthropometric indices of body mass index (BMI), waist-to-hip ratio (WHR), and conicity index (CI) were calculated using weight, height, HC and WC. Total body fatness (TBF) in kg was measured using a Hologic QDR 4500 W dual-energy X-ray absorptiometry (DEXA) scanner. RESULTS: There was an increasing trend of TBF, %TBF (percent total body fatness) and the five anthropometric indices in successively older age groups. Compared with females, males generally had high average BMI, WC, HC, WHR and CI, but had low average TBF and %TBF. Except for some correlations in 25-29 years age groups, TBF and %TBF were significantly correlated with five anthropometric indices with the Pearson's correlation coefficients ranging from 0.07 to 0.87. Principal component analysis (PCA) was performed to form four principal components (PCs) that interpreted over 99% of the total variation of the five related anthropometric indices in all age groups, with over 53% of the total variation accounted for by the PC1. Multiple regression analyses showed that four PCs combined explained a greater variance (R (2)=55.2-80.8%) in TBF than did BMI alone (R (2)=40-74.9%). CONCLUSION: Our results suggest that there is an increasing trend of total fat mass and five anthropometric indices with aging; that age and sex have the important effects on influencing the correlations of TBF and the studied anthropometric indices; and that the accuracy of predicting the TBF using five anthropometric indices is higher than using BMI alone.

Absorptiometry, Photon↗

Platelet indices as quality markers of platelet concentrates during storage.

The quality of platelet concentrates (PC) is an important issue in transfusion therapy. Recently, platelet indices have been used as markers for the quality control of PCs, as these reflect storage-induced shape changes in platelets. We also analyzed platelet indices such as platelet count, which could be detrimental and influence the rate of pH change during acceptable storage conditions. In the present study, platelet indices (with and without EDTA) were analyzed in stored PC. Forty pooled PRP-PCs were stored for 7 days and various platelet indices were analyzed with and without EDTA incubation. These indices included platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW) and platelet large cell ratio (PLCR). Difference in platelet paramters dPLT, dMPV, dPDW and dPLCR were calculated. Platelet indices correlating with pH changes, as determined by regression analysis, included dMPV and dPDW, while dPLT did not show much correlation (P < 0.05). Mean pH decreased from 7.25 to 6.86 between day 0 and day 7, respectively (P > 0.05). Platelet indices correlating with pH included PDW and MPV, while PLT did not show much correlation with pH. The platelet index dPDW (r = -0.26) and dMPV (r = -0.18) showed maximum, but not perfect, correlation with pH (P < 0.01). The coefficient of determination (R2) was maximum for the platelet indices dPDW and dP-LCR (R2 > 0.6). We conclude that measurements of platelet indices after EDTA incubation have great potential as quality markers of PC, especially when analyzed in combination with pH.

Biomarkers↗

Reliability of cerebral blood flow measurements by transcerebral double-indicator dilution technique.

BACKGROUND AND OBJECTIVE: The recently developed transcerebral double-indicator dilution technique has proven to be a feasible monitoring alternative to measure global cerebral blood flow at the bedside. However, the short-term repeatability of transcerebral double-indicator dilution measurements has not yet been investigated. The present study was designed to investigate the accuracy in terms of reliability for repeated transcerebral double-indicator dilution measurements to assess global cerebral blood flow during a definite carbon dioxide challenge in a clinical trial. METHODS: The investigation was performed in 10 patients scheduled for elective coronary artery bypass grafting. After induction of anaesthesia, repeated cerebral blood flow measurements using transcerebral double-indicator dilution were performed during target normocapnia, hypocapnia and hypercapnia. For transcerebral double-indicator dilution measurements, a bolus injection of ice-cold indocyanine green was administered into a central vein. The resulting thermal dye dilution curves were recorded simultaneously in the aorta and the jugular bulb using combined fibreoptic thermistor catheters. Cerebral blood flow was calculated from the mean transit times of the indicators through the brain. Additionally, transcranial Doppler sonography was simultaneously performed to measure transient changes in the cerebral blood flow velocity. RESULTS: Transcerebral double-indicator dilution measurements revealed a reasonable coefficient of repeatability with 9.1, 9.7 and 20.2 mL min-1 100 g-1 during normo-, hypo- and hypercapnic conditions, respectively. However, a total of 20% of the administered measurements had to be rejected for methodological reasons. CONCLUSIONS: Repeated measurements with the transcerebral double-indicator dilution method show a reasonable repeatability. With consideration to the limitations of the transcerebral double-indicator dilution technique, this new method proves to be a reliable monitoring tool to measure global cerebral blood flow at the bedside.

Aged↗

Comparison of thallium-201 uptake and retention indices for evaluation of brain lesions with SPECT.

Thallium-201 chloride single photon emission computed tomography ((201)TlCl SPECT) has been applied extensively for studies of human tumors. To assess which indices for (201)TlCl SPECT are most useful for diagnosing brain lesions, a total of 82 patients (98 images) with intracranial abnormalities were investigated. Seventy-six cases with abnormal (201)Tl uptake were evaluated in terms of six different (201)Tl uptake and retention indices: (1) average early (201)Tl uptake = Av.Le/Av.Be; (2) maximum early (201)Tl uptake = Mx.Le/Av.Be; (3)(201) Tl retention A = Av.Ld/Av.Le; (4) (201)Tl retention B = Mx.Ld/Mx.Le; (5) (201)Tl retention C = (Av.Ld/Av.Bd)/(Av.Le/Av.Be); (6) (201)Tl retention D = (Mx.Ld/Av.Bd)/(Mx.Le/Av.Be), where Av.Le and Mx.Le are average and maximum early counts for lesions, Av.Be and Av.Bd are average early and delayed counts for contralateral normal brains, and Av.Ld and Mx.Ld are average and maximum delayed counts for lesions. Comparison of patients with benign and malignant lesions did not demonstrate significant differences with any of the indices. However, low (I-II) and high (III-IV) grade astrocytomas varied in their average and maximum early (201)Tl uptake indices (both P = 0.0026). For patients with and without meningiomas, P values for indices of maximum early(201) Tl uptake and (201)Tl retention A and B were 0.0338, 0.0005, 0.0002, respectively. While comparison of patients with metastatic brain tumors and gliomas again showed no significant differences between the groups, the presence or absence of calcification was associated with significant variation in all the indices. With (201)TlCl-SPECT imaging, the average and maximum early (201)Tl uptake indices are appropriate for the assessment of tumor viability or malignancy, while (201)Tl retention indices (A,B) are useful for tumor differentiation, especially with meningiomas. Choice of suitable indices should enhance the utility of (201)TlCl-SPECT imaging in pre- and postoperative evaluation of intracranial lesions.

Adolescent↗

Completion pneumonectomy: current indications, complications, and results.

OBJECTIVE: Completion pneumonectomy is reported to be associated with high morbidity and mortality, especially when done in patients with benign disease. We review our 9 years of experience with this operation to evaluate the postoperative outcome and long-term results of various indications. METHODS: Between January 1990 and December 1998, 66 consecutive patients underwent completion pneumonectomy (6.8% of all pneumonectomies), and their cases were retrospectively reviewed. The indication was benign disease in 17 patients and malignant disease in 49 patients. In patients with malignant indications there were 14 local recurrences, 4 second primary tumors, 5 metastatic diseases, and 26 indications because of incomplete initial resection. RESULTS: There were no intraoperative deaths, and the postoperative mortality rate was 7.6%. Complications were encountered in 32 (53%) patients, without any significant difference between benign indication (71%) and malignant indication (47%; P =.0923). Bronchopleural fistula was encountered in 5 (7.6%) patients, and empyema was encountered in 7 (11%) patients. The actuarial 5-year survival was 57% for all patients, 65% for those with benign indications, and 54% for those with malignant indications (60% for local recurrence, 50% for second primary tumor, and 56% for incomplete resection), without any difference between benign and malignant indications (P =.9478). CONCLUSIONS: Completion pneumonectomy can be performed with acceptable mortality and morbidity, even in patients with benign disease. Patients with preoperative infection can be managed with bronchial stump covering and adequate postoperative drainage. Although complications are common, they can successfully be managed with a proper understanding of them.

Adult↗

The use of performance indicators in performance analysis.

The aims of this paper are to examine the application of performance indicators in different sports and, using the different structural definitions of games, to make general recommendations about the use and application of these indicators. Formal games are classified into three categories: net and wall games, invasion games, and striking and fielding games. The different types of sports are also sub-categorized by the rules of scoring and ending the respective matches. These classes are analysed further, to enable definition of useful performance indicators and to examine similarities and differences in the analysis of the different categories of game. The indices of performance are sub-categorized into general match indicators, tactical indicators, technical indicators and biomechanical indicators. Different research examples and the accuracy of their presentation are discussed. We conclude that, to enable a full and objective interpretation of the data from the analysis of a performance, comparisons of data are vital. In addition, any analysis of the distribution of actions across the playing surface should also be presented normalized, or non-dimensionalized, to the total distribution of actions across the area. Other normalizations of performance indicators should also be used more widely in conjunction with the accepted forms of data analysis. Finally, we recommend that biomechanists should pay more attention to games to enrich the analysis of performance in these sports.

Biomechanical Phenomena↗

Fluorescent chloride indicators to assess the efficacy of CFTR cDNA delivery.

Cl(-)-sensitive fluorescent indicators have been used extensively in cell culture systems to measure the Cl(-)-transporting function of the cystic fibrosis transmembrane conductance regulator protein CFTR. These indicators have been used in establishing a surrogate end point to assess the efficacy of CFTR cDNA delivery in human gene therapy trials. The ability to measure Cl- transport with high sensitivity in small and heterogeneous tissue samples makes the use of Cl- indicators potentially attractive in gene delivery studies. In this review article, the important technical aspects of Cl- transport measurements by fluorescent indicators such as SPQ are described, applications of Cl- indicators to assay CFTR function are critically evaluated, and new methodological developments are discussed. The available Cl- indicators have been effective in quantifying Cl- transport rates in cell culture models and in vitro systems such as isolated membrane vesicles and liposomes. However, the imperfect photophysical properties of existing Cl- indicators limit their utility in performing measurements in airway tissues, where gene transfer vectors are delivered in CF gene therapy trials. The low efficiency of gene transfer and the cellular heterogeneity in airway samples pose substantial obstacles to functional measurements of CFTR expression. Significant new developments in generating long-wavelength and dual-wavelength halide indicators are described, and recommendations are proposed for the use of the indicators in gene therapy trials.

Cell Membrane↗

Definition and estimation of higher-order gene fixation indices.

Fixation indices summarize the associations between genes that arise from the joint effects of inbreeding and selection. In this paper, fixation indices are derived for pairs, triplets and quadruplets of genes at a single multiallelic locus. The fixation indices are obtained by dividing cumulants by constants; the cumulants describe the statistical distribution of alleles and the constants are functions of gene frequency. The use of cumulants instead of moments is necessary only for four-gene indices, when the fourth cumulant is used. A second type of four-gene index is also required, and this index is based upon the covariation of second-order cumulants. At multiallelic loci, a large number of indices is possible. If alleles are selectively neutral, the number of indices is reduced and the relationship between gene identity and gene cumulants is shown.--Two-gene indices can always be estimated from genotypic frequency data at a single polymorphic locus. Three-gene indices are also estimable except when allele frequency equals one-half. Four-gene indices are not estimable unless selection is assumed to have an equal effect upon each allele (such as under selective neutrality) and the locus contains at least three alleles of unequal frequency. For diallelic or selected loci, an alternative four-gene fixation index is proposed. This index incorporates both types of four-gene associations but cannot be related to gene identity.

Alleles↗

Urinary iodine excretion is the most appropriate outcome indicator for iodine deficiency at field conditions at district level.

To empower local authorities to plan and evaluate adequate interventions, appropriate iodine deficiency disorders (IDD) indicators need to be identified. The aim of this study was to describe the magnitude and severity of IDD with different outcome indicators and associate them with functional indicators. Schoolchildren (n = 544) aged 8-10 y were assessed in 11 villages within five subdistricts of Malang District, East Java, Indonesia. Outcome indicators of IDD were goiter size as measured by palpation and ultrasonography (USG), urinary iodine excretion (UIE) and serum thyroid stimulating hormone (TSH) concentration in blood as well as functional indicators such as intellectual performance (IQ: Catell's Culture Fair Intelligence Test) and anthropometric indices. The total goiter rate (TGR) measured by palpation and USG were 35.7 and 54.4%, respectively. Based on UIE and TSH, the prevalence of iodine deficiency was 63.7 and 3.4%, respectively. In individuals, goiter, thyroid volume and UIE were associated significantly (r = -0.35; P < 0.001 and r = -0.30; P = 0.02 respectively). Among villages, TGR measured by palpation was significantly correlated with thyroid volume (r = 0.61; P = 0.045) and UIE (r = 0.68; P = 0.021), whereas TSH was not significantly associated with any of the observed indicators in individuals or groups. Multiple regression analysis showed that USG (beta = -0.67; P < 0.001) and UIE (beta = 4.39; P = 0.008) related significantly with cognitive performance (IQ). The associations between IDD indicators and cognitive performance and height-for-age Z scores suggest that socioeconomically advantaged children had better iodine status. We suggest that UIE is the best indicator for local authorities to assess iodine deficiency.

Child↗

No rise in renal Doppler resistance indices at peak serum levels of cyclosporin A in stable kidney transplant patients.

BACKGROUND: The measurement of intrarenal resistance indices by duplex ultrasound plays an important role in the follow-up care of renal transplant patients. Increasing resistance indices indicate rejection episodes, but may also occur e.g. in parenchymal renal diseases. As calcineurin inhibitors induce vasoconstriction both in vivo and in vitro, we studied whether peak serum levels of cyclosporin A led to an acute rise in renal resistance indices via the induction of intrarenal vasoconstriction. METHODS: The acute impact of peak serum levels of cyclosporin A on intrarenal resistance indices was studied in 36 patients after allogeneic renal transplantation. All patients were transplanted for > 6 months and received an immunosuppressive treatment comprising cyclosporin A. Intrarenal resistance indices were measured by duplex ultrasound immediately before (trough serum level) and 2 h after (peak serum level) the oral intake of cyclosporin A at the individual maintenance dose. RESULTS: Compared with renal resistance indices measured at trough serum levels [resistive index (RI) 0.72 +/- 0.07; pulsatility index (PI) 1.40 +/- 0.27], values remained unchanged at peak serum levels of cyclosporin A (RI 0.72 +/- 0.08; PI 1.43 +/- 0.31). Renal resistance indices correlated with the age of the patients, but not with mean arterial pressure or time since transplantation. CONCLUSIONS: The oral intake of cyclosporin A does not induce an acute rise in intrarenal resistance indices in stable transplanted patients. Thus, timing of duplex ultrasound examinations with regard to the intake of cyclosporin A is not necessary in these patients.

Adolescent↗

Water quality indicators and the risk of illness at beaches with nonpoint sources of fecal contamination.

BACKGROUND: Indicator bacteria are a good predictor of illness at marine beaches that have point sources of pollution with human fecal content. Few studies have addressed the utility of indicator bacteria where nonpoint sources are the dominant fecal input. Extrapolating current water-quality thresholds to such locations is uncertain. METHODS: In a cohort of 8797 beachgoers at Mission Bay, California, we measured baseline health at the time of exposure and 2 weeks later. Water samples were analyzed for bacterial indicators (enterococcus, fecal coliforms, total coliforms) using both traditional and nontraditional methods, ie, chromogenic substrate or quantitative polymerase chain reaction. A novel bacterial indicator (Bacteroides) and viruses (coliphage, adenovirus, norovirus) also were measured. Associations of 14 health outcomes with both water exposure and water quality indicators were assessed. RESULTS: Diarrhea and skin rash incidence were the only symptoms that were increased in swimmers compared with nonswimmers. The incidence of illness was not associated with any of the indicators that traditionally are used to monitor beaches. Among nontraditional water quality indicators, associations with illness were observed only for male-specific coliphage, although a low number of participants were exposed to water at times when coliphage was detected. CONCLUSIONS: Traditional fecal indicators currently used to monitor these beaches were not associated with health risks. These results suggest a need for alternative indicators of water quality where nonpoint sources are dominant fecal contributors.

Adolescent↗

Forty years of changing indications in penetrating keratoplasty in Israel.

PURPOSE: To examine the leading indications for keratoplasty and identify the changing trends in the past 40 years in Israel. METHODS: Pathology reports of all penetrating keratoplasties (PKPs) performed at Hadassah-Hebrew University Hospital from 1961 to 2000 were reviewed. We evaluated the indications for keratoplasty in each decade between the years 1961 and 2000. RESULTS: During the 40-year period, a total of 1681 PKPs were performed. Keratoconus (n = 478, 28.4%) was the most common indication, followed by graft failure (n = 226, 13.4%), pseudophakic corneal edema (PCE) (n = 142, 8.4%), herpetic infections (n = 125, 7.4%), nonherpetic infections (n = 114, 6.8%), scarring (n = 113, 6.7%), and trauma (n = 110, 6.5%). The 7 groups account for approximately 77.5% of all keratoplasties performed. Ocular infections were the most common indications before 1970 and have been declining ever since. Keratoconus became the leading indication in the past 30 years. In the past decade, of 663 keratoplasties, keratoconus was the most common indication (56, 38.6%) followed by graft failures/rejections and PCE (the second most common indication between the years 1981 and 1990). CONCLUSIONS: Keratoconus was the leading indication for keratoplasty in our series. There was a decreasing trend in PK for ocular herpetic infections during the decades. The rate of PCE decreased while failed graft became the second most common indication for PKP during the past decade.

Cornea↗

Comorbidity indices to predict mortality from Medicare data: results from the national registry of atrial fibrillation.

BACKGROUND: By accounting for level of comorbidity, risk-adjustment models should quantify the risk of death. How accurately comorbidity indices predict risk of death in Medicare beneficiaries with atrial fibrillation is unclear. OBJECTIVES: We sought to quantify how well 3 administrative-data based comorbidity indices (Deyo, Romano, and Elixhauser) predict mortality compared with a chart-review index. DESIGN: We undertook a retrospective cohort study using Medicare claim data (1995-1999) and medical record review. SUBJECTS: We studied Medicare beneficiaries (n = 2728; mean age = 77) with a common cardiac dysrhythmia, atrial fibrillation. MEASURES: The outcome was time to death with the accuracy of the comorbidity indices measured by the c-statistic. RESULTS: Correlation between Deyo and Romano indices was strong, but weak between them and the other indices. Prevalence of many comorbidity conditions varied with different indices. Compared with demographic data alone (c = 0.64), all comorbidity indices predicted death significantly (P < 0.001) better: the c index was 0.76 for Deyo, 0.78 for Romano, 0.76 for Elixhauser, and 0.75 for medical record review. The 95% confidence intervals of the c-statistic for the 4 indices overlapped with one another. Key comorbidity conditions for death included metastatic cancer, neuropsychiatric disease, heart failure, and liver disease. CONCLUSION: The predictive accuracy of 3 administrative-data based indices was similar and comparable with chart-review.

Aged↗

Simulation of machine-specific topographic indices for use across platforms.

PURPOSE: The objective of this project is to simulate the current published topographic indices used for the detection and evaluation of keratoconus to allow their application to maps acquired from multiple topographic machines. METHODS: A retrospective analysis was performed on 21 eyes of 14 previously diagnosed keratoconus patients from a single practice using a Tomey TMS-1, an Alcon EyeMap, and a Keratron Topographer. Maps that could not be processed or that contained processing errors were excluded from analysis. Topographic indices native to each of the three devices were recorded from each map. Software was written in ANSI standard C to simulate the indices based on the published formulas and/or descriptions to extend the functionality of The Ohio State University Corneal Topography Tool (OSUCTT), a software package designed to accept the input from many corneal topographic devices and provide consistent display and analysis. Twenty indices were simulated. Linear regression analysis was performed between each simulated index and the corresponding native index. A cross-platform comparison using regression analysis was also performed. RESULTS: All simulated indices were significantly correlated with the corresponding native indices (p < 0.01), with a mean R of 0.84, ranging from 0.42 to 0.99. Cross-platform comparisons were nonsignificant for specific indices and devices. CONCLUSION: Topographic indices native to three devices were successfully simulated. Cross-platform comparisons may be limited for specific indices.

Computer Simulation↗

Developing indicators for European birds.

The global pledge to deliver 'a significant reduction in the current rate of biodiversity loss by 2010' is echoed in a number of regional and national level targets. There is broad consensus, however, that in the absence of conservation action, biodiversity will continue to be lost at a rate unprecedented in the recent era. Remarkably, we lack a basic system to measure progress towards these targets and, in particular, we lack standard measures of biodiversity and procedures to construct and assess summary statistics. Here, we develop a simple classification of biodiversity indicators to assist their development and clarify purpose. We use European birds, as example taxa, to show how robust indicators can be constructed and how they can be interpreted. We have developed statistical methods to calculate supranational, multi-species indices using population data from national annual breeding bird surveys in Europe. Skilled volunteers using standardized field methods undertake data collection where methods and survey designs differ slightly across countries. Survey plots tend to be widely distributed at a national level, covering many bird species and habitats with reasonable representation. National species' indices are calculated using log-linear regression, which allows for plot turnover. Supranational species' indices are constructed by combining the national species' indices weighted by national population sizes of each species. Supranational, multi-species indicators are calculated by averaging the resulting indices. We show that common farmland birds in Europe have declined steeply over the last two decades, whereas woodland birds have not. Evidence elsewhere shows that the main driver of farmland bird declines is increased agricultural intensification. We argue that the farmland bird indicator is a useful surrogate for trends in other elements of biodiversity in this habitat.

Animals↗